Sometimes there are no words - even from me!

I am not a frequent visitor to the site of my e-pal Louise who occasionally comments here because, frankly, I am a bit of a moral coward.  Her site is sometimes painful and upsetting to read.  Louise, herself, suffers with that most elusive and sometimes destructive of disabilities, the ones that 'bend' the mind.  It has always been a remarkable fact that people may experience an event together, taking in information through their senses, and yet still come out with different descriptions of what occurred - as any experienced police officer will tell you who has regularly interviewed witnesses.  This 'normal' characteristic is made 'abnormal' when those concerned suffer with some sort of mental impairment which alters not only their view of individual events but also of their entire world view including, perhaps especially, their view of themselves inside this world.

In a recent post she describes the travails of Michael, an ex-soldier, mentally impaired to the point that he has fallen, or perhaps marched, through the cracks in society to end up as one of life's derelicts.  Now confined to a mental hospital he refuses, like Randle McMurphy in One Flew Over the Cuckoo's Nest, to take his meds and nightly the staff are required to use "reasonable force" (ie, six big men!) to administer them.  At this point one's sympathies are stretched to opposite poles, yes, one feels desperately sorry for Michael who is obviously a man with some considerable character but equally one cannot help but feel for the staff, too.  They are not, I am sure, all the equivalent of the repellent Nurse Ratched in Ken Kesey's one-sided drama.  People with disabling mental problems must be taken under care and control and those whose job it is to administer them must do what they think is necessary even if the state of knowledge of mental disorder is still in its infancy.

In other words, it's a 'no win' situation and I feel real anguish for the people concerned - on both sides of the meds!  Thank goodness Louise is out of hospital and continues to fight her own lonely battle with some success judging by her excellent blog.

 

Comments

[dearieme]

"knowledge of mental disorder is still in its infancy": it may be worse that that, Duffers. It may be that ignorance is nearly complete and that the fashion of how to treat madmen just goes in cycles.

[Whyaxye]

Probably the most sensible line to take in such matters is to avoid taking sides, so to speak. We feel ourselves wanting to "sort out" these disturbed individuals; and then we feel ourselves revolted by the treatment they receive when someone else is paid to sort them out; and then we realise that the medics are only doing their best under very difficult circumstances; etc. Our mind oscillates back and forth because it is too painful.

Well done to you for recognising this, and not rushing to easy judgements.

[David Duff]

Even defining what constitutes a 'madman' is hideously difficult, DM.

I suppose, 'W', that the only definite thing is that those likely to harm others (not easy to judge with exactitude) must be locked up and medicated; and those likely to harm themselves must be helped in whatever way seems appropriate. I just wish -and hope - that those with the responsibility act with due care and intelligence. Well, one can hope!

[Able]

Just an observation from someone, who although it is not my speciality, has some experience of the area, as well as over-lap of treating people with mental health issues.

Perspective, as in all things, is everything.

The imagery of "six beefy men" is almost frightening and yet.. seven is mandated by law and health and safety, to protect the person being restrained (one each for legs, arms, torso and to stabilise and protect the head, with one standing observing, controlling to ensure no injury). Then again, as a 6' 5" male, 'beefy' male mental health nurses appear, from twenty-mumble years experience, rather thin on the ground (whilst males are a greater percentage in mental health nursing than any other area the vast majority of staff remain the average small female). Then again the description is, understandably, reticent about just what Michaels behaviour without neuroleptics was like (most patients injuries in secure units are, not surprisingly, received from other patients), would her view have been different if subjected to such an attack, probably but irrelevant.

The protections against wrongful confinement and treatment against a persons wishes are so numerous and byzantine to almost make it impossible, and yet.. with some the hoops have to be jumped through (not only to prevent them from harming others but themselves as well, more often in fact). As an aside, its not just in mental health circles this issue exists - try contracting Tuberculosis (open pulmonary) and refusing treatment to see what I mean.

I, personally, think that the balance (almost entirely in favour of patients rights) is correct (with multiple independent professionals needed to institute a 'Section', constant reviews, independent and adversarial advocates present throughout,...). My one issue is that with the closure of the large institutions (in common with general medicine for that matter) the majority, who enter voluntarily in times of need, are left without support.

The motivation may have been 'moral' and the impetus 'financial' but the results have neither been moral (destitute victims, deaths, injuries and suffering) or any financial saving (the higher costs of 'care in the community' - but that's OK as it's 'someone elses budget').

I just don't know!

[rogerh]

Someone I know runs an old folks home. In selecting staff she has to choose people who are suited to the work - day after day, year after year. She has developed a feel for the kind of people who fit the work but then has to choose from those who will work for the wages/conditions etc. Not an easy balance at all - small wonder less fussy or more pressured establishments end up with trouble.

[David Duff]

Able, you describe exactly why it is so difficult for outsiders to make judgments in an area fraught with difficulties. By and large, if someone has a broken leg the treatment is standard and obvious but any attempt to heal a mind - assuming that you are satisfied that it needs 'healing' in the first place - is in difficulty from the off because all minds are individual, formed as they are from a zillion influences beginning with genes and honed by personal experiences. As you know, Able, I never hesitate to put the boot into the worst sort of 'psycho-babblers' but I do have considerable respect for those members of that profession who remain humble as they grope their way to some sort of soundly-based approach to mental ill-health. In the meantime I can only echo your own words - "I just don't know".

Roger, you touch on another important aspect of this problem. The "poor, bloody infantry" of this area of medical treatment should have the temperament of saints to do what they have to do day in, day out. But of course, they are not, they are people - with all that that word entails.